Provider Demographics
NPI:1164013249
Name:BURBY, DONNA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:BURBY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233B NC HIGHWAY 561 W
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-9742
Mailing Address - Country:US
Mailing Address - Phone:252-287-7877
Mailing Address - Fax:
Practice Address - Street 1:200 HAMPTON WOODS ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845
Practice Address - Country:US
Practice Address - Phone:252-534-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2898225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant